Facility Evaluation Report

On 06/22/2023, Licensing Program Analyst (LPA) Arielle Pascua arrived unannounced to this facility to conduct an annual visit. LPA Pascua was greeted by Staff Member(SM), Teresita Lim and explained the purpose of the visit. LPA asked that SM Lim called the Facility Designated Administrator( FDA) to inform them that CCL was present at this time. LPA was informed that the FDA was unable to come at this time and was to continue the visit with Teresita Lim. There was one other staff member present, Lyn Testmio.

This facility is licensed to serve 6 residents, of which all may be non-ambulatory and 1 may be bedridden. This facility also has a hospice waiver for 4 and has a dementia program on file.

LPA reviewed 5 resident files. 2 of 5 resident files did not have a proper medical assessment that was completed within the last 12 months. LPA reviewed 4 staff files. 4 out of 4 staff files were current and up to date.

Fire extinguisher located in the laundry room appeared to have been annually inspected and is valid until 07/07/2023.

The kitchen area was toured. LPA Pascua observed a sufficient seven days of non-perishable as well as two days worth of perishable food supplies in the main kitchen. Additional perishable supplies were identified in an additional freezer located in the garage. Knives and additional cleaning supplies were locked and made inaccessible to the residents at this time.

LPA Pascua observed a locked centralized stored medication cabinet located in the kitchen. Along with Caregiver, Baisas, the LPA observed, reviewed, and compared resident medication with the medication dispensing logs. First Aid Kit was present and contained all of the required components.

Common areas were toured. Living room, dining area and all other areas intended for resident use were observed to be furnished and maintained in compliance at this time.

Laundry area was toured. Laundry detergent, bleach, and all other cleaning supplies were observed to be locked and made inaccessible to the residents at this time.

A tour of the garage was conducted. Additional storage for supplies were stored in cabinets. All additional cleaning supplies were locked and made inaccessible to the residents at this time.

A tour of the resident bedrooms was conducted. Resident furniture was observed to be sufficient to meet the resident needs at this time. A tour of the staff bedroom was also conducted.